School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Norwegian Institute of Public Health, Oslo, Norway.
Implement Sci. 2018 Jan 25;13(Suppl 1):12. doi: 10.1186/s13012-017-0694-5.
The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on a probable fifth component, dissemination bias. Given its exploratory nature, we are not yet able to provide guidance on applying this potential component of the CERQual approach. Instead, we focus on how dissemination bias might be conceptualised in the context of qualitative research and the potential impact dissemination bias might have on an overall assessment of confidence in a review finding. We also set out a proposed research agenda in this area.
We developed this paper by gathering feedback from relevant research communities, searching MEDLINE and Web of Science to identify and characterise the existing literature discussing or assessing dissemination bias in qualitative research and its wider implications, developing consensus through project group meetings, and conducting an online survey of the extent, awareness and perceptions of dissemination bias in qualitative research.
We have defined dissemination bias in qualitative research as a systematic distortion of the phenomenon of interest due to selective dissemination of studies or individual study findings. Dissemination bias is important for qualitative evidence syntheses as the selective dissemination of qualitative studies and/or study findings may distort our understanding of the phenomena that these syntheses aim to explore and thereby undermine our confidence in these findings. Dissemination bias has been extensively examined in the context of randomised controlled trials and systematic reviews of such studies. The effects of potential dissemination bias are formally considered, as publication bias, within the GRADE approach. However, the issue has received almost no attention in the context of qualitative research. Because of very limited understanding of dissemination bias and its potential impact on review findings in the context of qualitative evidence syntheses, this component is currently not included in the GRADE-CERQual approach.
Further research is needed to establish the extent and impacts of dissemination bias in qualitative research and the extent to which dissemination bias needs to be taken into account when we assess how much confidence we have in findings from qualitative evidence syntheses.
GRADE-CERQual（对定性研究证据综述的信心评估）方法由 GRADE（推荐评估、制定和评价分级）工作组开发。该方法旨在支持在决策中使用定性证据综合的结果，包括指南制定和政策制定。CERQual 包括评估对综述中定性研究结果的信心程度的四个组成部分（也称为定性证据综合）：（1）方法学限制，（2）一致性，（3）数据充分性，（4）相关性。本文是一系列关于如何应用 CERQual 的指南的一部分，重点介绍了一个可能的第五个组成部分，即传播偏倚。由于其探索性性质，我们还不能提供关于应用 CERQual 方法这一潜在组成部分的指南。相反，我们专注于如何在定性研究的背景下概念化传播偏倚，以及传播偏倚可能对综述结果的信心整体评估产生的潜在影响。我们还在该领域提出了一个拟议的研究议程。
我们通过从相关研究社区收集反馈，搜索 MEDLINE 和 Web of Science 来识别和描述讨论或评估定性研究中传播偏倚及其更广泛影响的现有文献，通过项目组会议达成共识，并对定性研究中传播偏倚的程度、意识和看法进行在线调查，从而制定了本文。
我们将定性研究中的传播偏倚定义为由于选择性传播研究或个别研究结果，对感兴趣的现象的系统性扭曲。传播偏倚对于定性证据综合很重要，因为选择性传播定性研究和/或研究结果可能会扭曲我们对这些综合旨在探索的现象的理解，从而破坏我们对这些结果的信心。在随机对照试验和此类研究的系统综述的背景下，已经广泛研究了传播偏倚。在 GRADE 方法中，作为发表偏倚，正式考虑了潜在传播偏倚的影响。然而，在定性研究的背景下，这个问题几乎没有得到关注。由于对定性证据综合中传播偏倚及其对综述结果的潜在影响的理解非常有限，因此该组成部分目前未包含在 GRADE-CERQual 方法中。
需要进一步研究以确定定性研究中传播偏倚的程度和影响，以及在评估我们对定性证据综合结果的信心程度时需要考虑传播偏倚的程度。
